Proposal for a state option for health care coverage - creation - division of insurance - appropriation. The act requires the department of health care policy and financing and the division of insurance in the department of regulatory agencies (departments) to develop and submit a proposal (proposal) to certain committees of the general assembly concerning the design, costs, benefits, and implementation of a state option for health care coverage. Additionally, the departments shall present a summary of the proposal at the annual joint hearings with the legislative committees of reference during the interim before the 2020 legislative session.

The proposal must contain a detailed description of a state option and must identify the most effective implementation of a state option based on affordability to consumers at different income levels, administrative and financial burden to the state, ease of implementation, and likelihood of success in meeting the objectives described in the act. The proposal must also identify any necessary changes to state law to implement the proposal.

In developing the proposal, the departments shall engage in a stakeholder process that includes public and private health insurance experts, consumers, consumer advocates, employers, providers, and carriers. Further, the departments shall review any information relating to a pilot program operated by the state personnel director as a result of legislation that may be enacted during the 2019 legislative session.

The departments shall prepare and submit any necessary federal waivers or state plan amendments to implement the proposal, unless a bill is filed within the filing deadlines for the 2020 legislative session that substantially alters the federal authorization required for the proposal and the bill is not postponed indefinitely in the first committee.

For the 2018-19 state fiscal year, the act appropriates $75,000 from the general fund to the department of health care policy and financing for professional services, and $115,500 from the general fund to the department of regulatory agencies for the division of insurance for personal services.

For the 2019-20 state fiscal year, the act appropriates $150,000 from the general fund to the department of health care policy and financing for professional services, and $231,000 from the general fund to the department of regulatory agencies for the division of insurance for personal services.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Income tax - tax credit - eligible early childhood educators. The act provides a refundable income tax credit to an eligible early childhood educator with a federal adjusted gross income less than or equal to $75,000 for an individual filing a single return, or less than or equal to $85,000 for an individual filing a joint return, who, for at least 6 months of the taxable year for which the credit is claimed, holds an early childhood professional credential and is either the licensee of an eligible program or employed by an eligible program. The act specifies that an eligible program means either an early childhood education program or a licensed family child care home and the eligible program must have held at least a level 2 quality rating under the Colorado shines quality rating and improvement system for the income tax year for which the credit is claimed and, for the income tax year for which the credit is claimed, either have fiscal agreements with the Colorado child care assistance program or be a program that meets the federal early head start or head start standards. The amount of the credit is dependent on the eligible early childhood educator's credentialing level and is annually adjusted for inflation. The department of human services is required to provide to the department of revenue an annual report of each individual who held an early childhood professional credential during the previous calendar year for which the income tax credit is allowed.

The act takes effect only if, at the November 2019 statewide election, a majority of voters do not approve a referred measure that allows the state to increase the cigarette tax, increase the tobacco products tax, and to create a new tax on nicotine products and use a significant portion of the tax revenue for preschool programs and expanded learning opportunities. If the voters at the November 2019 statewide election do not approve such a measure, then the act takes effect on the date of the official declaration of the vote thereon by the governor.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Recovery from substance use disorders - housing vouchers - recovery residence standards and requirements - recovery residence certification grant program - creation of the opioid crisis recovery funds advisory committee - appropriation. The act:

• Expands the housing voucher program currently within the department of local affairs to include individuals with a substance use disorder;
• Establishes standards for recovery residences for purposes of referrals and title protection and prohibits a facility from using the terms "recovery residence", "sober living facility", or "sober home" unless the facility meets specified conditions;
• Creates the recovery residence certification grant program; and
• Creates the opioid crisis recovery funds advisory committee to advise and collaborate with the department of law on uses of any custodial funds the state receives as settlement or damage awards resulting from opioid-related litigation.

To implement the act:

• $1,000,000 is appropriated to the department of local affairs;
• $2,620 is appropriated to the office of the governor for use by the office of information technology; and
• $50,000 is appropriated to the department of human services for use by the office of behavioral health.
  (Note: This summary applies to this bill as enacted.)

Fiscal Note

Child care expenses - income tax credit - individuals with low income - extension. For income tax years prior to January 1, 2021, a resident individual who has a federal adjusted gross income of $25,000 or less may claim a refundable state income tax credit for child care expenses for the care of a dependent who is less than 13 years old. The act extends the tax credit for 8 years.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Colorado K-5 social and emotional heath act - pilot program - appropriation. The act creates the "Colorado K-5 Social and Emotional Health Act" (health act). Subject to available appropriations, the health act requires the department of education (department) to select up to 10 pilot schools (pilot school) to participate in a pilot program that ensures that a school mental health professional, as defined in the health act, is dedicated to each of grades kindergarten through fifth grade, with a ratio of mental health professionals to students of approximately one per 250 students. To the extent possible, the school mental health professional shall follow the same students through each grade. The general assembly shall appropriate the resources necessary for the pilot school to hire or contract with the additional school mental health professionals. The department shall select pilot schools that meet the characteristics outlined in the health act, including high poverty, ethnic diversity, and a large concentration of students in the foster care system.

Among other responsibilities consistent with the mental health professional's license, the school mental health professional shall provide needed services to students and their families in the pilot school, including providing services and supports to students with learning disabilities, identifying food insecurities, providing resources to develop and improve the social and emotional health of students, and helping eligible students and their families access public benefits. Services must be provided at school and during school hours, as appropriate.

The health act requires the department to employ or contract with a pilot program coordinator to oversee the implementation of the pilot program across the pilot schools.

The pilot program begins operation during the 2020-21 school year and repeals in July 2023. The department shall contract with a professional program evaluator (evaluator) to conduct a preliminary evaluation in 2022 and a final evaluation before the repeal of the pilot program. The evaluator shall establish the method for the collection and monitoring of the pilot schools' data throughout the pilot program. The evaluator shall evaluate the effectiveness of services provided by the pilot program on the academic, mental, and physical health and well-being of the student cohorts within the scope of the pilot program.

The health act authorizes the use of marijuana tax cash fund money and gifts, grants, or donations to fund the pilot program.

For the 2019-20 state fiscal year, the act appropriates $43,114 and 0.4 FTE from the marijuana tax cash fund to the department of education to implement the health act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

The bill repeals statutory provisions:

• Prohibiting the possession of certain ammunition magazines; and
• Requiring each of certain ammunition magazines that are manufactured in Colorado on or after July 1, 2013, to include a permanent stamp or marking indicating that the magazine was manufactured or assembled after July 1, 2013.
  (Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill extends the right to use deadly physical force against an intruder under certain conditions to include owners, managers, and employees of a business.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

The bill requires an agency or nonprofit organization operating a clean syringe exchange program to submit an annual environmental impact mitigation plan (plan) to its county or district board of health detailing:

• The number of syringes received from clean syringe exchange program participants in the previous calendar year;
• The number of syringes given to clean syringe exchange program participants in the previous calendar year;
• The agency's or nonprofit organization's plan to minimize the number of syringes near the clean syringe exchange program location that have not been disposed of safely; and
• The agency's or nonprofit organization's plan to minimize the environmental impacts of unsafe or improper syringe disposal.

The county or district must forward the plan to the department of public health and environment (department). The department must compile the information received from all county and district boards of health and report the information to the general assembly during the department's "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Comprehensive human sexuality education - content requirements - grant program - appropriation. The act adds certain content requirements for public schools that offer comprehensive human sexuality education, including instruction on consent as it relates to safe and healthy relationships and safe haven laws.

The act prohibits instruction from emphasizing sexual abstinence as the primary or sole acceptable preventive method available to students and prohibits instruction from explicitly or implicitly using shame-based or stigmatizing language or instructional tools; employing gender stereotypes; or excluding the health needs of lesbian, gay, bisexual, or transgender individuals.

If a public school teaches comprehensive human sexuality education, the public school is not required to include instruction on pregnancy outcome options. However, if a public school opts to provide instruction on pregnancy outcome options, it must cover all pregnancy outcome options available.

Current law provides for a comprehensive human sexuality education grant program. The act amends certain provisions of the grant program to:

• Require the department of public health and environment to submit an annual report concerning the outcomes of the grant program indefinitely;
• Add 9 representatives to the oversight entity and require membership of the oversight entity to represent diverse community perspective and make an effort to include committee members who are diverse;
• Require grant applicants to demonstrate a need for money to implement comprehensive human sexuality education; and
• Require that rural public schools or public schools that do not currently offer comprehensive human sexuality education receive priority when selecting grant applicants.

The act prohibits the state board of education from waiving the content requirements for any public school that provides comprehensive human sexuality education. However, the act does not prohibit charter schools or institute charter schools from applying for a waiver.

For the 2019-20 state fiscal year, the act appropriates $1,000,000 from the general fund to the department of public health and environment to implement the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Regulation of cigarettes, tobacco products, or nicotine products - local government regulation - state cigarette tax revenue apportionment to local governments - local governments' special sales taxes. Sections 1, 2, and 4 of the act authorize a county to enact a resolution or ordinance that prohibits a minor from possessing or purchasing cigarettes, tobacco products, or nicotine products. Sections 1 and 2 also authorize a county to impose regulations on cigarettes, tobacco products, or nicotine products that are more stringent than statewide regulations, including prohibiting sales to a person under 21 years of age, and section 4 expressly authorizes a county to enact a resolution or ordinance regulating the sale of cigarettes, tobacco products, or nicotine products to minors. Section 3 expressly authorizes a statutory or home rule city or town to enact an ordinance regulating the sale of cigarettes, tobacco products, or nicotine products to minors.

From state income tax money, the state currently apportions an amount equal to 27% of state cigarette tax revenues to cities, towns, and counties in proportion to the amount of state sales tax revenues collected within their boundaries. In order to receive their allocation of this money, cities, towns, and counties are prohibited from imposing their own fees, licenses, or taxes on cigarette sales or from attempting to impose a tax on cigarettes. Section 5 removes this prohibition with respect to fees or licenses that a city, town, or county imposes or with respect to a tax that a city, town, or county attempts to impose, thus allowing cities, towns, and counties to impose fees or licenses or to attempt to impose taxes on cigarette sales without losing their apportioned state cigarette tax revenues. A city, town, or county that successfully imposes a tax on cigarette sales loses its apportioned state cigarette tax revenues.

Section 6 authorizes a statutory or home rule city or town, city and county, or county, if approved by a vote of the people within the statutory or home rule city or town, city and county, or county, to impose a special sales tax on the sale of cigarettes, tobacco products, or nicotine products. Section 6 also provides a mechanism by which a county's special sales tax applies to a municipality within the boundary of the county unless the municipality, if approved by a vote of the people within the municipality, enacts its own such special sales tax; however, the county and municipality may then enter into an intergovernmental agreement authorizing the county to continue to levy, collect, and enforce its special sales tax within the corporate limits of the municipality.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Registrar of vital statistics - department of revenue - issuance of new a birth certificate, driver's license, or identity document - requirements - appropriation. Under current law, a person born in Colorado who seeks a new birth certificate from the registrar of vital statistics (state registrar) to reflect a change in gender designation must obtain a court order indicating that the sex of the person has been changed by surgical procedure and ordering that the gender designation on the birth certificate be amended, and the person must obtain a court order with a legal name change. The act:

• Repeals that provision and creates new requirements for the issuance of birth certificates to a person who has a gender different from the sex denoted on that person's birth certificate;
• Requires that the state registrar issue a new birth certificate rather than an amended birth certificate. The act allows a person who has previously obtained an amended birth certificate under previous versions of the law to apply to receive a new birth certificate. A person is not required to obtain a court order for a legal name change in order to obtain a new birth certificate with a change in gender designation;
• Gives the courts in this state jurisdiction to issue a decree to amend a birth certificate to reflect a change in sex designation for persons born in another state or foreign jurisdiction if the law of such other state or foreign jurisdiction requires a court decree in order to amend a birth certificate to reflect a change in sex designation;
• Creates new requirements for the issuance of a new driver's license or identity document to a person who has a gender different from the sex denoted on that person's driver's license or identity document after certain documents are submitted to the department of revenue;
• Exempts transgender persons from having to submit a public notice of name change.

The act appropriates $58,500 from the licensing services cash fund to the department of revenue for use by the division of motor vehicles for DRIVES maintenance and support.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

With certain exceptions, current law limits the authority of a person who holds a valid permit to carry a concealed handgun by prohibiting a permit holder from carrying a concealed handgun on public elementary, middle, junior high, or high school grounds. The bill removes this limitation.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Section 2 of the bill establishes leave savings accounts. A leave savings account is an account with a financial institution for which the individual uses money to pay for any expense while he or she is on eligible leave, which includes:

• The birth of a child of the individual and in order to care for the child;
• The placement of a child with the individual for adoption or foster care;
• Caring for a spouse, child, or parent of the individual if the spouse, child, or parent has a serious health condition;
• A serious health condition that makes the individual unable to perform the functions of the position of the individual; or
• Any qualifying exigency, as determined by the United States secretary of labor, arising out of the fact that a spouse, child, or parent of the individual is on covered active duty, or has been notified of an impending call or order to covered active duty, in the United States armed forces.

An individual may annually contribute up to $5,000 of state pretax wages to a leave savings account. Employers may also make a matching contribution to an employee's leave savings account. The department of revenue is required to establish a form about a leave savings account, and the individual must annually file this form to be eligible for the tax benefit.

Sections 3 and 4 allow an employee and an employer to claim a state income tax deduction for amounts they contribute to the employee's leave savings account. Section 3 also allows a taxpayer to deduct any interest or other income earned on the investment during the taxable year from their leave savings account.

Regardless of how the money is deposited in the leave savings account, if an individual uses money in the account for an unauthorized purpose, then the money is subject to recapture in the year it is withdrawn and to a penalty equal to 10% of the amount recaptured.

Section 5 creates an income tax credit for an employer that pays an employee for leave that is between 6 and 12 weeks long for one of the following reasons:

• The birth of a child of the employee and in order to care for the child;
• Placement of a child with the employee for adoption or foster care;
• Caring for a spouse, child, or parent of the employee if the spouse, child, or parent has a serious health condition;
• A serious health condition that makes the employee unable to perform the functions of the position of the employee; or
• Any qualifying exigency, as determined by the United States secretary of labor, arising out of the fact that a spouse, child, or parent of the employee is on covered active duty, or has been notified of an impending call or order to covered active duty, in the United States armed forces.

For employers with fewer than 50 employees, the credit is equal to 50% of the amount paid, and for employers with 50 or more employees it is equal to 25% of the amount paid. The credit is not refundable, but it may be carried forward up to 5 years.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Smoking restrictions - application to vape and e-cigarette use - exemptions - age restrictions in permitted smoking areas - signage - penalties. The act amends the "Colorado Clean Indoor Air Act" by:

• Adding a definition of "electronic smoking device" (ESD) to include e-cigarettes and similar devices within the scope of the act;
• Citing the results of recent research on ESD emissions and their effects on human health as part of the legislative declaration;
• Eliminating the existing exceptions for certain places of business in which smoking may be permitted, such as airport smoking concessions, businesses with 3 or fewer employees, designated smoking rooms in hotels, and designated smoking areas in assisted living facilities;
• Repealing the ability of property owners and managers to designate smoking areas through the posting of signs;
• Exempting FDA-approved nebulizers, inhalers, and vaporizers, as well as humidifiers that emit only water vapor, from the definition of an ESD;
• Amending signage requirements for tobacco businesses and vape shops that must notify customers of prohibitions on entry by persons under the age of 18;
• Increasing the radius of an "entryway", the area around the doorway to a building where smoking is not permitted, from a minimum of 15 feet to a minimum of 25 feet except where existing local regulations permitted a smaller radius when construction or renovation of a business commenced, on or before July 1, 2019; and
• Creates a grace period, affirmative defenses, and graduated penalties for enforcement of the amended signage requirements and age restrictions for tobacco businesses and vape shops.

The act takes effect July 1, 2019, except for the provisions requiring exclusion of minors and the posting of appropriate signage relating to the exclusion, which provisions take effect October 1, 2019.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Pharmacists - chronic maintenance drugs - dispense without prescription. The act allows a pharmacist to dispense an emergency supply of a chronic maintenance drug to a patient without a prescription if:

• The pharmacist is unable to obtain authorization to refill the prescription from a health care provider;
• The pharmacist has a record of a prescription in the name of the patient who is requesting the emergency supply of the chronic maintenance drug, or, in the pharmacist's professional judgment, the refusal to dispense an emergency supply will endanger the health of the patient;
• The amount of the chronic maintenance drug dispensed does not exceed the amount of the most recent prescription or the standard quantity or unit of use package of the drug;
• The pharmacist has not dispensed an emergency supply of the chronic maintenance drug to the same patient in the previous 12-month period; and
• The prescriber of the drug has not indicated that no emergency refills are authorized.

The act requires the state board of pharmacy to promulgate rules to establish standard procedures for dispensing chronic maintenance drugs. A pharmacist, the pharmacist's employer, and the original prescriber of the drug are not civilly liable for dispensing a chronic maintenance drug unless there is negligence, recklessness, or willful or wanton misconduct.

Specified provisions of the act are contingent upon House Bill 19-1172 becoming law.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

The bill creates the employment support and job retention services program (program) within the division of employment and training (division) in the department of labor and employment (department) to provide emergency employment support and job retention services to eligible individuals in the state. The bill requires the director of the division (director) to contract with an entity to administer the program to provide reimbursement for employment support and job retention services provided to eligible individuals statewide. In order to be eligible for services for which a service provider may be reimbursed under the program, an individual must be 16 years of age or older, be eligible to work in the United States, have a household income that is at or below the federal poverty line, and be underemployed or unemployed and actively involved in employment preparation, job training, employment pursuit, or job retention activities. The director is required to establish procedures and guidelines to implement and set parameters for the operation of the program.

The general assembly is required to appropriate money to the employment support and job retention services cash fund created in the bill for allocation to the division to implement and operate the program. The department is authorized to accept gifts, grants, and donations for the implementation and operation of the program. The program is repealed, effective September 30, 2022.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Psychotherapy services - treatment of a minor without parental consent - mental health education resource bank - appropriation. The act allows a minor 12 years of age or older to seek and obtain psychotherapy services with or without the consent of the minor's parent or guardian if the mental health professional determines the minor is knowingly and voluntarily seeking the psychotherapy services and the psychotherapy services are clinically necessary. A mental health professional providing psychotherapy services to a minor may, with the consent of the minor, advise the minor's parent or legal guardian of the psychotherapy services provided, unless notifying the parent or legal guardian would be inappropriate or detrimental to the minor's care and treatment. However, the mental health professional is permitted to notify the minor's parent or legal guardian without the minor's consent if, in the opinion of the mental health professional, the minor is unable to manage his or her care or treatment.

The mental health professional is required to engage the minor in a discussion about the importance of involving and notifying the minor's parent or legal guardian and document any attempt to contact the minor's parent or legal guardian. If a minor communicates a clear and imminent threat to commit suicide, the mental health professional is required to notify the minor's parent or legal guardian of the minor's suicidal ideation.

The act requires the department of education, in consultation with the office of suicide prevention, the youth advisory council, and the suicide prevention commission, to create and maintain a mental health education literacy resource bank. The resource bank is available to the public free of charge. The act also requires the state board of education to adopt standards related to mental health, including suicide prevention.

The act appropriates $116,550 from the general fund to the department of education for the mental health education resource bank and technical assistance.

Specifies that certain provisions take effect only if House Bill 19-1172 becomes law.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Maternal mortality review committee - creation - appointments - duties - sunset review - appropriation. The act creates the Colorado maternal mortality review committee (committee), which is required to review maternal deaths, identify the causes of maternal mortality, and develop recommendations to address preventable maternal deaths, including legislation, policies, rules, and best practices that will support the health and safety of the pregnant and postpartum population in Colorado and prevent maternal deaths. The executive director of the department of public health and environment (department) is directed to appoint at least 11 members to serve on the committee.

The act requires certain health care providers and law enforcement officials to provide medical records to the department concerning each maternal death for access by the members of the committee. The records, notes, information, and activities of the committee are confidential.

The committee is repealed, effective September 1, 2029, and is subject to sunset review by the department of regulatory agencies prior to its repeal.

$145,167 is appropriated to the department for implementation of the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Lieutenant governor - office of saving people money on health care - director. Under current law, the lieutenant governor is authorized to concurrently serve as the head of a principal department while serving as the lieutenant governor. The act expands this to allow the lieutenant governor to alternatively serve as the director of the office of saving people money on health care within the office of the governor. The act further specifies the salary to be paid for working concurrently in this position.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Physicians - mental health care providers - conversion therapy for minors prohibited - disciplinary action. The act prohibits a licensed physician specializing in psychiatry or a licensed, certified, or registered mental health care provider from engaging in conversion therapy with a patient under 18 years of age. A licensee who engages in these practices is subject to disciplinary action by the appropriate licensing board. "Conversion therapy" means efforts to change an individual's sexual orientation, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attraction or feelings toward individuals of the same sex.

Specified provisions of the act are contingent upon House Bill 19-1172 becoming law.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Colorado food - school grant program - nonprofit grant program - appropriation. The act establishes a grant program in the department of education (CDE) to encourage providers that are entitled to federal money for lunches for students (participating providers) to purchase food products from Colorado growers, producers, and processors (Colorado food). The grant program reimburses participating providers for the amount of Colorado food that the provider purchased in the previous school year. The act caps the reimbursements at $500,000 per year.

The act establishes a separate program in CDE to make a grant to a nonprofit organization to make grants to entities that promote the sale of Colorado food to schools and to eligible providers to encourage the purchase of Colorado food. The nonprofit organization is required to conduct an annual evaluation and report to CDE.

For the 2019-20 state fiscal year, the act appropriates $168,942 from the general fund to CDE for the school purchasing programs.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

The bill exempts a person's primary residence from attachment or execution of a lien as the result of a judgment for medical debt. A person recording a transcript of judgment must record an affidavit with the transcript stating that the signer is an authorized agent of the judgment creditor and whether the judgment is for medical debt. A judgment debtor may record an affidavit with the county stating the debtor's name, a description of the debtor's interest in the property, and that the property is the debtor's primary residence. A primary residence is defined as a person's dwelling place and includes the dwelling, the lot or lots on which the dwelling is situated, including a farm of any number of acres, and any appurtenances.

The bill takes effect on January 1, 2020, and applies to judgments entered on or after that date.

(Note: This summary applies to this bill as introduced.)

Fiscal Note

Residential mental health facility - pilot program - appropriation. The act creates a new 3-year mental health facility pilot program to provide residential care, treatment, and services to persons with either a mental health diagnosis or a physical health diagnosis. It contains requirements for applicants and directs the department of public health and environment (department) to select one or 2 applicants for the pilot program.

The act appropriates $30,370 to the department for use by the health facilities and emergency medical services division.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

The bill creates the health and wellness through comprehensive quality physical education instruction pilot program (pilot program) in the department of education (department).

The purpose of the pilot program is to allow a school or a school district, as defined in the bill, serving any of grades K-8, to apply for grant money to implement a pilot program in a school or in schools of a school district. The pilot program must be implemented in all K-8 grades in the school or school district.

Subject to available appropriations, pilot program grants are for 3 academic years and are awarded to up to 15 eligible schools or school districts for a total of not more than $3 million awarded annually, including department administrative expenses. Pilot program grants are awarded in February prior to the first academic year to allow grantees to create a 3-year plan for the use of the grant money.

The bill includes application deadlines and criteria for the award of grants. The department will review grant applications and make recommendations to the state board of education for the award of the pilot program grants.

Grant money awarded through the pilot program can be used only to implement comprehensive quality physical education instruction, as described in the bill. The bill lists the components that must be included in a comprehensive quality physical education instruction program.

The department shall contract with a program evaluator for purposes of completing a program evaluation of the pilot program at the end of the 3-year grant period. The bill lists program evaluation criteria. First priority shall be given to a vendor proposal from a state-supported institution of higher education that has the expertise necessary to assess the impact of the pilot program.

The bill requires annual reporting to the education committees of the senate and the house of representatives.

For the 2019-20 state fiscal year, the bill requires the general assembly to appropriate $1.1 million from the marijuana tax cash fund to the department to implement the pilot program. Unspent appropriations are further appropriated for the remainder of the pilot program to implement the pilot program.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Tenants and landlords - warranty of habitability - breach of warranty - tenants' remedies. Under current law, a warranty of habitability (warranty) is implied in every rental agreement for a residential premises. The act states that, except in cases involving a condition that is based on the presence of mold, a landlord commits a breach of the warranty (breach) if the residential premises is:

• Uninhabitable or otherwise unfit for human habitation or in a condition that materially interferes with the tenant's life, health, or safety; and
• The landlord has received reasonably complete written or electronic notice of the condition and failed to commence remedial action by employing reasonable efforts within:
• 24 hours, where the condition materially interferes with the tenant's life, health, or safety; or
• 96 hours, where the premises is uninhabitable or otherwise unfit for human habitation and the tenant has included with the notice permission for the landlord or the landlord's authorized agent to enter the residential premises.

For cases involving a residential premises that has mold that is associated with dampness, or where there is any other condition causing the residential premises to be damp, which condition, if not remedied, would materially interfere with the life, health, or safety of a tenant, a landlord commits a breach if the landlord fails:

• Within 96 hours after receiving reasonably complete written or electronic notice of the condition, to mitigate immediate risk of mold by installing a containment, stopping active sources of water to the mold, and installing a high-efficiency particulate air filtration device to reduce tenants' exposure to mold;
• To maintain the containment until certain acts have been performed; and
• Within a reasonable amount of time, to execute certain remedial actions to remove the health risk posed by mold.

Current law provides a list of conditions that render a residential premises uninhabitable. To this list, the act adds 2 conditions; specifically, a residential premises is uninhabitable if:

• The premises lacks functioning appliances that conformed to applicable law at the time of installation and that are maintained in good working order; or
• There is mold that is associated with dampness, or there is any other condition causing the residential premises to be damp, which condition, if not remedied, would materially interfere with the health or safety of the tenant, excluding the presence of mold that is minor and found on surfaces that can accumulate moisture as part of their proper functioning and intended use.

The act grants jurisdiction to county courts to provide injunctive relief related to a breach.

The act also:

• States that if a tenant gives a landlord notice of a condition that materially interferes with the tenant's life, health, or safety, the landlord, at the request of the tenant, shall provide the tenant a comparable dwelling unit, as selected by the landlord, at no expense or cost to the tenant, or a hotel room, as selected by the landlord, at no expense or cost to the tenant;
• Allows a tenant who satisfies certain conditions to deduct from one or more rent payments the cost to repair or remedy a condition causing a breach;
• Repeals the requirement that a tenant notify a local government before seeking an injunction for a breach;
• Repeals provisions that allow a rental agreement to require a tenant to assume certain responsibilities concerning conditions and characteristics of a residential premises;
• Creates an exception for single-family residence premises for which a landlord does not receive a subsidy from any governmental source, by which exception a landlord and tenant may agree in writing that the tenant is to perform specific repairs, maintenance tasks, alterations, and remodeling, subject to certain requirements;
• Prohibits a landlord from retaliating against a tenant in response to the tenant having made a good-faith complaint to the landlord or to a governmental agency alleging a condition that renders the premises uninhabitable or any condition that materially interferes with the life, health, or safety of the tenant;
• Repeals certain presumptions that favor landlords; and
• Specifies monetary damages that may be available to a tenant against whom a landlord retaliates.

The act states that if the same condition that substantially caused a breach recurs within 6 months after the condition is repaired or remedied, other than a condition that merely involves a nonfunctioning appliance, the tenant may terminate the rental agreement 14 days after providing the landlord written or electronic notice of the tenant's intent to do so. In a case concerning a condition that merely involves a nonfunctioning appliance, if the landlord remedies the condition within 14 days after receiving the notice, the tenant may not terminate the rental agreement.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

School lunch - free and reduced price school lunch - appropriation. The act clarifies that all students in sixth through eighth grade participating in the federal reduced price school lunch program are eligible for the existing child nutrition school lunch protection program (program), and extends the grades of eligibility for the program to students through the twelfth grade.

For the 2019-20 state fiscal year, $463,729 is appropriated to the department of education from the general fund for the implementation of the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Health care cost analysis task force - creation - analysis of health care financing systems - report - gifts, grants, and donations - repeal - appropriation. The act creates the health care cost analysis task force (task force). The president of the senate, the minority leader of the senate, the speaker of the house of representatives, and the minority leader of the house of representatives shall each appoint one legislative member to the task force. The governor shall appoint 4 members to the task force. The executive directors of the departments of human services, public health and environment, and health care policy and financing, or their designees, also serve on the task force.

The task force is required to issue a competitive solicitation in order to select an analyst to provide a detailed analysis of fiscal costs and other impacts to 3 health care financing systems. The health care financing systems to be analyzed are:

• The current health care financing system, in which residents receive health care coverage from private and public insurance carriers or are uninsured;
• A multi-payer universal health care system, in which all residents of Colorado are covered under a plan with a mandated set of benefits that is publicly funded and paid for by employer and employee contributions; and
• A publicly financed and privately delivered universal health care system that directly compensates providers.

The analyst may use the same specified criteria when conducting the analysis of each health care financing system.

The task force is required to report the findings of the analyst to the general assembly.

The task force may seek, accept, and expend gifts, grants, and donations for the analysis. The general assembly may appropriate money to the health care cost analysis cash fund for the purposes of the task force, the analysis, and reporting requirements.

The act appropriates $92,649 to the department of health care policy and financing from the general fund to implement the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Firearms - extreme risk protection order - petition requirements - hearings - firearm surrender options - termination hearing - appropriation. The act creates the ability for a family or household member or a law enforcement officer to petition the court for a temporary extreme risk protection order (ERPO) beginning on January 1, 2020. The petitioner must establish by a preponderance of the evidence that a person poses a significant risk to self or others by having a firearm in his or her custody or control or by possessing, purchasing, or receiving a firearm. The petitioner must submit an affidavit signed under oath and penalty of perjury that sets forth facts to support the issuance of a temporary ERPO and a reasonable basis for believing they exist. The court must hold a temporary ERPO hearing in person or by telephone on the day the petition is filed or on the court day immediately following the day the petition is filed.

After issuance of a temporary ERPO, the court must schedule a second hearing no later than 14 days following the issuance to determine whether the issuance of a continuing ERPO is warranted. The court shall appoint counsel to represent the respondent at the hearing. If a family or household member or a law enforcement officer establishes by clear and convincing evidence that a person poses a significant risk to self or others by having a firearm in his or her custody or control or by possessing, purchasing, or receiving a firearm, the court may issue a continuing ERPO. The ERPO prohibits the respondent from possessing, controlling, purchasing, or receiving a firearm for 364 days.

Upon issuance of the ERPO, the respondent shall surrender all of his or her firearms and his or her concealed carry permit if the respondent has one. The respondent may surrender his or her firearms either to a law enforcement agency or a federally licensed firearms dealer, or, if the firearm is an antique or relic or curio, the firearm may be surrendered to a family member who is eligible to possess a firearm and who does not reside with the respondent. If a person other than the respondent is determined to be the lawful owner of any firearms surrendered to law enforcement, the firearm must be returned to him or her.

The respondent can motion the court once during the 364-day ERPO for a hearing to terminate the ERPO. The respondent has the burden of proof at a termination hearing. The court shall terminate the ERPO if the respondent establishes by clear and convincing evidence that he or she no longer poses a significant risk of causing personal injury to self or others by having in his or her custody or control a firearm or by purchasing, possessing, or receiving a firearm. The court may continue the hearing if the court cannot issue an order for termination at that time but believes there is a strong possibility the court could issue a termination order prior to the expiration of the ERPO.

The petitioner requesting the original ERPO may request an extension of the ERPO before it expires. The petitioner must show by clear and convincing evidence that the respondent continues to pose a significant risk of causing personal injury to self or others by having a firearm in his or her custody or control or by purchasing, possessing, or receiving a firearm. If the ERPO expires or is terminated, all of the respondent's firearms must be returned within 3 days of the respondent requesting return.

The act requires the state court administrator to develop and prepare standard petitions and ERPO forms. Additionally, the state court administrator at the judicial department's "State Measurement for Accountable, Responsive, and Transparent (SMART) Government Act" hearing shall provide statistics related to petitions for ERPOs.

The act appropriates $119,392 from the general fund to the judicial department for court costs, jury costs, and court-appointed counsel costs.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Wage garnishment - disposable earnings - hardship exemption - notice - applicability. Under current law, the amount of an individual's disposable earnings subject to garnishment is either 25% of the individual's disposable weekly earnings or the amount by which an individual's disposable earnings for a week exceed 30 times the state or federal minimum wage, whichever is less. The act changes the amount subject to garnishment to 20% of the individual's disposable weekly earnings 40 times the amount by which an individual's disposable earnings for a week exceed the state or federal minimum wage.

Currently, the cost of court-ordered health insurance for a child provided by an individual is deducted from the individual's disposable earnings subject to garnishment. The act also deducts from an individual's disposable earnings subject to garnishment the cost of any health insurance that is provided by the individual's employer and voluntarily withheld from the individual's earnings.

The act creates an exemption that would permit individuals to prove that the amount of their pay subject to garnishment should be further reduced or eliminated altogether if the individual can establish that such reductions are necessary to support the individual or the individual's family. The act also requires clearer and more timely notice to an individual whose wages are being garnished and gives the individual more time after receiving the notice before garnishment starts.

The act applies to all writs of garnishment issued on or after October 1, 2020, regardless of the date of the judgment that is basis of the writ of garnishment.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Income tax - affordable housing tax credit - increase in aggregate amount of tax credits that may be allocated annually. Currently, under the affordable housing tax credit, during each calendar year of the period beginning in 2015 and ending in 2024 the Colorado housing and finance authority (CHFA) may allocate tax credits in an aggregate amount up to $5 million annually. The act increases the annual aggregate cap to $10 million for the years beginning on January 1, 2020, and ending on December 31, 2024.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Primary care - collaborative created - affordability standards - targets - payment reform recommendations. The act:

• Establishes a primary care payment reform collaborative in the division of insurance in the department of regulatory agencies;
• Requires the commissioner of insurance to establish affordability standards for premiums, including adding targets for carrier investments in primary care; and
• Requires the department of health care policy and financing and carriers who offer health benefit plans to state employees to set targets for investment in primary care.
  (Note: This summary applies to this bill as enacted.)

Fiscal Note

Behavioral, mental health, and substance use disorders - parity in coverage - private insurance - medicaid - coverage of medication-assisted treatment - parity reporting requirements - compliance with federal law - complaints from ombudsman for behavioral health access to care - rules - appropriation. The act enacts the "Behavioral Health Care Coverage Modernization Act" to address issues related to coverage of behavioral, mental health, and substance use disorder services under private health insurance and the state medical assistance program (medicaid).

With regard to health insurance, the act:

• Specifies that mandatory insurance coverage for behavioral, mental health, and substance use disorders includes coverage for the prevention of, screening for, and treatment of those disorders and must comply with the federal "Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008" (MHPAEA) (section 3 of the act);
• Requires services for behavioral, mental health, and substance use disorders to continue while a claim for coverage of those services is under review until the carrier notifies the covered person of the determination on the claim (section 3);
• Requires carriers to comply with treatment limitation requirements specified in federal regulations and precludes carriers from applying nonquantitative treatment limitations to behavioral, mental health, and substance use disorder services that do not apply to medical and surgical benefits (section 3);
• Requires carriers to establish procedures to authorize treatment by nonparticipating providers when a participating provider is not available under network adequacy requirements and to reimburse treatment or services for behavioral, mental health, or substance use disorders obtained from a nonparticipating provider because the covered service was not available within established time and distance standards using the same methodology the carrier uses to reimburse covered medical services provided by nonparticipating providers (section 3);
• Requires the commissioner of insurance (commissioner) to adopt rules to establish reasonable time periods for visits with a provider for treatment of a behavioral, mental health, or substance use disorder after an initial visit with a provider (section 3);
• Modifies the definition of "behavioral, mental health, and substance use disorder" to include diagnostic categories listed in the mental disorders section of the International Statistical Classification of Diseases and Related Health Problems, the Diagnostic and Statistical Manual of Mental Disorders, or the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (section 3);
• Updates the required coverage related to alcohol use and behavioral health screenings to reflect the current requirements of that coverage as specified in recommendations of the United States preventive services task force (section 3);
• Requires the commissioner to disapprove a carrier's requested rate increase for failure to demonstrate compliance with the MHPAEA in accordance with rules adopted by the commissioner (section 5);
• For purposes of denials of reimbursement for behavioral, mental health, or substance use disorder services, other than denials based on nonpayment of premiums, requires carriers to include specified information about the protections included in the MHPAEA, how to contact the division of insurance or the office of the ombudsman for behavioral health access to care (office) related to possible violations of the MHPAEA, and the right to request medical necessity criteria from the carrier free of charge (section 6);
• For health benefit plans issued or renewed on or after January 1, 2020, requires carriers that provide coverage for an annual physical examination as a preventive health care service to also cover and reimburse for behavioral health screenings using a validated screening tool for behavioral health to the same extent the physical examination is covered (section 8);
• Requires carriers to submit an annual parity report to the commissioner and requires the commissioner to examine complaints received from the office regarding compliance with the requirements of the act or the MHPAEA upon the request of the office (section 9);
• Starting January 1, 2020, for a carrier that provides prescription drug benefits for the treatment of substance use disorders, with regard to prescription medications that are on the carrier's formulary, requires the carrier to provide coverage of any FDA-approved prescription medication for treating substance use disorders without prior authorization or step therapy requirements and to place at least one covered substance use disorder prescription medication on the lowest tier of the drug formulary, and precludes those carriers from excluding coverage for those medications and related services solely on the grounds that they were court ordered (section 10); and
• Requires the commissioner to provide a report by December 1, 2022, to specified legislative committees regarding the effects of the act on premiums (section 10).

With regard to medicaid, the act:

• Requires the department of health care policy and financing (department) to ensure that medicaid covers behavioral, mental health, and substance use disorder services to the extent that medicaid covers a physical illness and complies with the MHPAEA (section 11);
• Requires the medical services board (state board) to establish a procedure, by rule, to allow for reimbursements of medically necessary state plan behavioral, mental health, or substance use services under medicaid when a managed care entity (MCE) denies coverage of the service based on diagnosis (section 11);
• Requires the statewide system of community behavioral health care in the managed care system to require MCEs to provide an adequate network of providers of behavioral, mental health, and substance use disorder services and to cover all medically necessary covered treatments for covered behavioral health diagnoses, regardless of any co-occurring conditions (section 12);
• Requires the department to include utilization management guidelines for the MCEs in state board managed care rules and to provide information on its website specifying how the public may request the network adequacy plans and quarterly network reports for an MCE (section 12);
• Requires the department to examine complaints received from the office regarding compliance with the requirements of the act or the MHPAEA upon the request of the office (section 12);
• Requires MCEs to include specified statements regarding the applicability of the MHPAEA to the managed care system in medicaid and how to contact the office regarding possible violations of the MHPAEA (section 14);
• Requires the department to submit an annual parity report to specified legislative committees and to contract with an external quality review organization annually to monitor MCEs' utilization management programs and policies to ensure compliance with the MHPAEA (section 15); and
• Starting January 1, 2020, requires an MCE that provides prescription drug benefits for the treatment of substance use disorders to provide coverage of any FDA-approved prescription medication for treating substance use disorders without prior authorization or step therapy requirements and precludes those MCEs from excluding coverage for those medications and related services solely on the grounds that they were court ordered (section 15).

The act appropriates $167,000 to the department of health care policy and financing and $88,248 to the department of regulatory agencies to implement the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Access to behavioral health treatment - capacity tracking system - care navigation program - building substance use disorder treatment capacity in underserved communities grant program - appropriation. The act:

• Directs the department of human services to implement a centralized, web-based behavioral health capacity tracking system to track available treatment capacity at behavioral health facilities and at programs for medication-assisted treatment and withdrawal management for substance use disorders, as well as other types of treatment;
• Directs the department of human services to implement a care navigation program to assist individuals in obtaining access to treatment for substance use disorders, including medical detoxification and residential and inpatient treatment; and
• Creates the building substance use disorder treatment capacity in underserved communities grant program to provide services in rural and frontier communities, prioritizing areas of the state that are unserved or underserved.

For the 2019-20 state fiscal year, the act appropriates:

• $31,961 and 0.8 FTE to the department of health care policy and financing, executive director's office for personal services and operating expenses, with the expectation that the department will receive additional federal funding;
• $5,589,344 and 2.5 FTE from the marijuana tax cash fund to the department of human services, office of behavioral health, for community behavioral health administration, the behavioral health capacity tracking system, the care navigation program, and the building substance use disorder treatment capacity in underserved communities grant program; and
• $160,206 and 1.4 FTE from reappropriated funds received from the department of human services to the office of the governor for use by the office of information technology.
  (Note: This summary applies to this bill as enacted.)

Fiscal Note

The bill requires the department of public health and environment (department) to:

• Develop a standardized form and submission process to claim a medical exemption to an immunization; and
• Develop a standardized form and submission process to claim a religious or personal belief exemption to an immunization.

The department is:

• Required to develop educational materials regarding immunizations to distribute to health care providers and facilities;
• Required to present immunization exemption information during its annual SMART Act hearing; and
• Required to use the existing immunization tracking system.

The state board of health is:

• Required to promulgate rules adopting the medical exemption recommendations from the advisory committee on immunization practices of the centers for disease control and prevention in the federal department of health and human services, or any successor entity (ACIP);
• Required to promulgate rules adopting the the hepatitis A, rotavirus, and meningococcal immunizations; and
• Allowed to promulgate rules establishing the timing by which schools, parents, legal guardians, and students must demonstrate compliance with immunization requirements.

Concerning the immunization tracking system, the bill:

• Requires a licensed physician, physician assistant, or advanced practice nurse to inform a parent or legal guardian who is claiming a medical exemption that he or she may choose to exclude the student's immunization information from the immunization tracking system before the student's immunization data is sent to the immunization tracking system;
• Requires the department or local or county, district, or municipal public health agency to inform a parent, legal guardian, or student who is claiming a religious or personal belief exemption that he or she may choose to exclude the student's immunization information from the immunization tracking system before the student's immunization data is sent to the immunization tracking system; and
• Requires a practitioner who is a licensed physician, physician assistant, or advanced practice nurse to submit immunization and medical exemption data to the immunization tracking system. However, the practitioner is not subject to a regulatory sanction for noncompliance.
  (Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Health care providers' accountability to communities - community health needs assessments - community benefit implementation plans - public meetings. The act requires the following hospitals to complete a community health needs assessment every 3 years and an annual community benefit implementation plan every year:

• A hospital that is licensed as a general hospital and exempt from federal taxation;
• A hospital established pursuant to the Denver health and hospital authority; and
• A hospital established pursuant to the University of Colorado hospital authority.

Each such hospital must report to the department of health care policy and financing (department) concerning certain community benefits, costs, and shortfalls in the preceding year, and the department is required to submit an annual summary report to subject matter committees of the general assembly. Hospitals that are licensed as general hospitals but that are not required to report may report in like fashion. The department shall develop and provide a website at which each reporting hospital shall submit reports.

The act requires each hospital to convene a public meeting at least once each year to seek feedback regarding the hospital's community benefit activities during the previous year and the hospital's community benefit implementation plan for the following year. Each hospital shall invite representatives from certain local entities and state agencies to participate in the meeting. Each hospital shall also invite the general public to the meeting in an advertisement placed in any major newspaper published in the hospital's community.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Medication-assisted treatment expansion pilot program - extension - administration - additional counties to participate - funding increase - appropriation. In 2017, the general assembly enacted Senate Bill 17-074, concerning the creation of a pilot program in certain areas of the state experiencing high levels of opioid addiction to award grants to increase access to addiction treatment, which created a 2-year medication-assisted treatment (MAT) expansion pilot program, administered by the university of Colorado college of nursing, to expand access to medication-assisted treatment to opioid-dependent patients in Pueblo and Routt counties and directed the general assembly to appropriate $500,000 per year for the 2017-18 and 2018-19 fiscal years from the marijuana tax cash fund to the university of Colorado board of regents for allocation to the college of nursing to implement the pilot program. The 2017 act also scheduled the pilot program for repeal on June 30, 2020.

The act:

• Expands the pilot program to the counties in the San Luis valley and 2 additional counties in which a need is demonstrated;
• Shifts responsibility to administer the pilot program from the college of nursing to the center for research into substance use disorder prevention, treatment, and recovery support strategies;
• Adds representatives from the San Luis valley and any other counties selected to participate in the pilot program and members from the boards of county commissioners from participating counties to the advisory board that assists in administering the program;
• Increases the annual appropriation for the pilot program to $2.5 million for the 2019-20 and 2020-21 fiscal years; and
• Extends the program an additional 2 years.

The act appropriates $2.5 million from the marijuana tax cash fund to the department of higher education for use by the board of regents of the university of Colorado to allocate to the center for research into substance use disorder prevention, treatment, and recovery support strategies for the MAT expansion pilot program.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Health care cooperatives - consumer protections - consumers negotiating rates.

The act modernizes laws authorizing health care cooperatives in the state to incorporate consumer protections such as coverage for preexisting conditions and to encourage consumers to help control health care costs by negotiating rates on a collective basis directly with providers. The act authorizes the commissioner of insurance to apply for a federal waiver as necessary to implement the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Prescription drugs - Canadian prescription drug importation program - federal approval - eligible importers and suppliers - eligible prescription drugs - distribution requirements - reports - rules - appropriations. The act creates the "Canadian Prescription Drug Importation Program" (program) in the department of health care policy and financing (department). On or before September 1, 2020, the department shall submit a request to the United States secretary of health and human services for approval of the program. The department shall begin operating the program not later than 6 months after receiving such approval. The department may expend money for the purpose of requesting approval of the program, but the department cannot spend any other money to implement the program until the department receives approval of the program.

Upon receiving approval of the program, the department shall contract with 1 or more vendors to provide services under the program. Each vendor, in consultation with the department and any other vendors, shall establish a wholesale prescription drug importation list (importation list) that identifies the prescription drugs that have the highest potential for cost savings to the state. Each vendor shall revise the list at least annually and at the direction of the department. The department shall review the importation list at least every 3 months to ensure that it continues to meet the requirements of the program. The department may direct a vendor to revise the list, as necessary.

Each vendor shall:

• Identify, in consultation with the department, Canadian suppliers who are in full compliance with relevant Canadian federal and provincial laws and regulations and who have agreed to export prescription drugs identified on the importation list;
• Verify that such Canadian suppliers meet the requirements of the program and will export prescription drugs at prices that provide cost savings to the state;
• Contract with such eligible Canadian suppliers, or facilitate contracts between eligible importers and Canadian suppliers, to import prescription drugs under the program;
• Assist the department in developing and administering a distribution program within the program;
• Assist the department with the preparation of an annual report and provide any information requested by the department for the report;
• Ensure the safety and quality of drugs imported under the program;
• Maintain a list of all eligible importers that participate in the program;
• Ensure compliance with the federal "Drug Quality and Security Act" by all Canadian suppliers, eligible importers, distributors, and other participants in the program;
• Provide an annual financial audit of its operations to the department;
• Provide to the department quarterly financial reports specific to the program, which reports must include information concerning the performance of the vendor's subcontractors and vendors;
• Submit evidence of a surety bond in an amount of at least $25,000 with any bid or initial contract negotiation documents and maintain documentation of evidence of the surety bond with the department throughout the contract term; and
• Maintain the information and documentation submitted to the department for at least 7 years.

The act imposes certain requirements for drugs that are imported under the program, and the act prohibits certain drugs from being imported under the program.

The act states that the following entities are eligible importers under the program:

• A pharmacist or wholesaler employed by or under contract with a medicaid pharmacy, for dispensing to the pharmacy's medicaid recipients;
• A pharmacist or wholesaler employed by or under contract with the department of corrections, for dispensing to inmates in the custody of the department of corrections;
• Commercial plans, as defined by rules promulgated by the medical services board and as approved by the federal government; and
• A licensed Colorado pharmacist or wholesaler approved by the department.

An eligible importer may import a prescription drug from a Canadian supplier if:

• The drug meets federal food and drug administration standards and is not a controlled substance, biological product, infused or intravenously injected drug, a drug that is inhaled during surgery, or a parenteral drug deemed a threat to public health; and
• Importing the drug is expected to generate cost savings and would not violate federal patent laws.

The act requires the department to designate an office or division that must be a licensed pharmaceutical wholesaler or that shall contract with a licensed pharmaceutical wholesaler. The designated office shall:

• Set a maximum profit margin so that a wholesaler, distributor, pharmacy, or other licensed provider participating in the program maintains a profit margin that is no greater than the profit margin that the wholesaler, distributor, pharmacy, or other licensed provider would have earned on the equivalent nonimported drug;
• Exclude generic products if the importation of the products would violate United States patent laws applicable to United States-branded products;
• Comply with certain federal requirements concerning drug quality and security; and
• Determine a method for covering the administrative costs of the program.

Each participating eligible importer and Canadian supplier shall submit to the vendor specified information about each drug to be acquired by the importer or to be supplied by the Canadian supplier under the program.

The department shall immediately suspend the importation of a specific drug or the importation of drugs by a specific eligible importer if it discovers that any drug or activity is in violation of the act or any federal or state law or regulation. The department may revoke the suspension if, after conducting an investigation, it determines that the public is adequately protected from counterfeit or unsafe drugs being imported into this state.

The executive director of the department shall promulgate rules as necessary for the administration of the program. The department shall approve a method of financing the administrative costs of the program, which method may include imposing a fee on each prescription pharmaceutical product sold through the program or any other appropriate method determined by the department to finance administrative costs. The department shall not require a fee in an amount that the department determines would significantly reduce consumer savings.

On or before December 1, 2021, and on or before December 1 each year thereafter, the department shall submit a report to the governor, the president of the senate, and the speaker of the house of representatives concerning the operation of the program during the previous fiscal year.

For the 2019-20 fiscal year, the act appropriates $1,041,802 to the department to implement the act, $134,719 of which is reappropriated to the department of law to provide legal services to the department.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Substance use disorders - alternatives to arrest and criminal charges for persons in need of substance use treatment - treatment in prisons and jails - record sealing - harm reduction program - appropriation. The act enacts policies related to the involvement of persons with substance use disorders in the criminal justice system. The Colorado commission on criminal and juvenile justice is required to study and make recommendations concerning:

• Alternatives to filing criminal charges against individuals with substance use disorders who have been arrested for drug-related offenses;
• Best practices for investigating unlawful opioid distribution in Colorado; and
• A process for automatically sealing criminal records for drug offense convictions.

Jails that receive funding through the jail-based behavioral health services program must have a policy in place on or before January 1, 2020, that describes how medication-assisted treatment will be provided, when necessary, to individuals in the jail. The jail may enter into agreements with community agencies and organizations to assist in the development and administration of medication-assisted treatment.

The department of corrections (DOC) is required to allow medication-assisted treatment to be provided to persons who were receiving treatment in a local jail prior to being transferred to the custody of the DOC. The DOC may enter into agreements with community agencies and organizations to assist in the development and administration of medication-assisted treatment.

The act adds to an existing legislative declaration that the substance abuse trend and response task force should formulate a response to current and emerging substance abuse problems from the criminal justice, prevention, and treatment sectors that includes the use of drop-off treatment services, mobile and walk-in crisis centers, and withdrawal management programs as an alternative to entry into the criminal justice system for offenders of low-level drug offenses.

The act creates a simplified process for sealing convictions for level 4 drug felonies, all drug misdemeanors, and any offense committed prior to October 1, 2013, that would have been a level 4 drug felony or drug misdemeanor if committed on or after October 1, 2013. A defendant may file a motion to seal records 3 years or more after final disposition of the criminal proceedings. Conviction records may be sealed only after a hearing and upon court order. This provision of the act is contingent upon House Bill 19-1275 being enacted and becoming law.

The harm reduction grant program is established to reduce health risks associated with drug use and improve coordination between law enforcement agencies, public health agencies, and community-based organizations. Grants may be awarded to nonprofit organizations, public health agencies, and law enforcement agencies. The department of regulatory agencies shall review the grant program prior to its scheduled repeal in 2024.

The following appropriations are made for the 2019-20 state fiscal year:

• $1,963,832 is appropriated from the general fund to the department of human services for use by the office of behavioral health;
• $492,750 is appropriated from the general fund to the department of corrections;
• $1,800,000 is appropriated from the marijuana tax cash fund to the harm reduction grant program, which the department of public health and environment is responsible for the accounting related to such appropriation; and
• $40,300 is appropriated from the general fund to the department of public safety for use by the division of criminal justice for administrative services.
  (Note: This summary applies to this bill as enacted.)

Fiscal Note

Behavioral health care professional matching grant program - use of grant money - behavioral health care services - contracts with community providers - appropriation. The act allows money from the behavioral health care professional matching grant program to be used for behavioral health care services at recipient schools and specifies that grants may also fund behavioral health services contracts with community providers. Grant applicants must specify the extent to which the school has seen an increase in activities or experiences that affect students' mental well-being. The act requires the department of education to prioritize grant applications based on the school's need for additional health professionals and the extent to which the school will prioritize the use of grant money for staff training related to behavioral health supports.

For the 2019-20 state fiscal year, the act appropriates $3,000,000 from the marijuana tax cash fund to the department of education for the behavioral health care professional matching grant program.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Current law prohibits the use of wireless telephones while driving for individuals who are younger than 18 years of age. The bill:

• Extends the prohibition to drivers of all ages;
• Extends the existing prohibition of the use of wireless telephones to include all mobile electronic devices;
• Establishes the penalties as $50 and 2 points for a first violation, $100 and 2 points for a second violation, $200 and 4 points for a third or subsequent violation, and $300 and 4 points if the violation involves text messaging;
• Creates an exception to the prohibition of the use of mobile electronic devices for adult drivers who use a mobile electronic device while a hands-free accessory is engaged; and
• Repeals a sentence enhancement for a violation that causes bodily injury or death.

Appropriates $7,425 to the department of revenue to implement the bill.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

Fiscal Note

Medical marijuana - disabling medical conditions - conditions for which a physician could prescribe an opioid. The act adds a condition for which a physician could prescribe an opioid to the list of disabling medical conditions that authorize a person to use medical marijuana for his or her condition. Under current law, a child under 18 years of age who wants to be added to the medical marijuana registry for a disabling medical condition must be diagnosed as having a disabling medical condition by 2 physicians, one of whom must be a board-certified pediatrician, a board-certified family physician, or a board-certified child and adolescent psychiatrist who attests that he or she is part of the patient's primary care provider team. The act removes the additional requirements on specific physicians to align with the constitutional provisions for a debilitating medical condition. The act states if the recommending physician is not the patient's primary care physician, the recommending physician shall review the records of a diagnosing physician or a licensed mental health provider acting within its scope of practice. The act limits a patient with a disabling medical condition who is under eighteen years of age to using medical marijuana only in a nonsmokeable form when using medical marijuana upon the grounds of the preschool or primary or secondary school in which the student is enrolled, or upon a school bus or at a school-sponsored event.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Statewide health care review committee - creation - membership - duties - appropriation. The act recreates the former health care task force, renamed as the statewide health care review committee, to study health care issues that affect Colorado residents. The committee consists of no more than 10 of the members from the house of representatives committees on health and insurance and public health care and human services and the senate committee on health and human services. The committee may hold 2 meetings during the interim between legislative sessions, each of which may be a field trip.

$16,062 is appropriated from the general fund to the legislative department to implement the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Prescribing health care practitioners - electronic prescribing of controlled substances - exceptions. The act requires health care practitioners with prescribing authority to prescribe schedule II, III, or IV controlled substances only via a prescription that is electronically transmitted to a pharmacy unless a specified exception applies. The requirement to electronically prescribe starts on July 1, 2021, for podiatrists, physicians, physician assistants, advanced practice nurses, and optometrists, and on July 1, 2023, for dentists and practitioners serving rural communities or in a solo practice. Prescribing practitioners are required to indicate on license renewal questionnaires whether they have complied with the electronic prescribing requirement.

Pharmacists need not verify the applicability of an exception to electronic prescribing when they receive an order for a controlled substance in writing, orally, or via facsimile transmission and may fill the order if otherwise valid under the law.

Specifies that certain sections take effect only if HB 19-1172 becomes law.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

State board of health - area trauma advisory councils - rules - repeal. The act repeals the requirement that the state board of health adopt rules and establish standards to ensure that area trauma advisory councils and managed care organizations are prepared for an emergency epidemic.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

State board of health - repeal authority over money for state and local public works or public health functions. The act repeals the state board of health's authority to accept, use, disburse, and administer money allotted to the department of public health and environment for state and local public works or public health functions.
(Note: This summary applies to this bill as enacted.)

Fiscal Note

Wage discrimination based on sex - complaints - civil action - exceptions to prohibitions against wage differentials - prohibited acts of employer - employment announcements required - enforcement - rules. The act removes the authority of the director of the division of labor standards and statistics in the department of labor and employment (director) to enforce wage discrimination complaints based on an employee's sex and instead authorizes the director to create and administer a process to accept and mediate complaints of, and provide legal resources concerning, alleged violations and to promulgate rules for this purpose. An aggrieved person may bring a civil action in district court to pursue remedies specified in the act.

The act allows exceptions to the prohibition against a wage differential based on sex if the employer demonstrates that a wage differential is not based on wage rate history and is based upon one or more of the following factors, so long as the employer applies the factors reasonably and they account for the entire wage rate differential:

• A seniority system;
• A merit system;
• A system that measures earnings by quantity or quality of production;
• The geographic location where the work is performed;
• Education, training, or experience to the extent that they are reasonably related to the work in question; or
• Travel, if the travel is a regular and necessary condition of the work performed.

The act prohibits an employer from:

• Seeking the wage rate history of a prospective employee or requiring disclosure of wage rate as a condition of employment;
• Relying on a prior wage rate to determine a wage rate;
• Discriminating or retaliating against a prospective employee for failing to disclose the employee's wage rate history;
• Discharging or retaliating against an employee for actions by an employee asserting the rights established by the act against an employer; or
• Discharging, disciplining, discriminating against, or otherwise interfering with an employee for inquiring about, disclosing, or discussing the employee's wage rate.

The act requires an employer to announce to all employees employment advancement opportunities and job openings and the pay range for the openings. The director is authorized to enforce actions against an employer concerning transparency in pay and employment opportunities, including fines of between $500 and $10,000 per violation.

Employers are also required to maintain records of job descriptions and wage rate history for each employee while employed and for 2 years after the employment ends. Failure to maintain these records creates a rebuttable presumption, in a lawsuit alleging wage discrimination based on sex, that the records not maintained contained information favorable to the employee's claim.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Oil and gas operations - air quality regulation - local government authority - oil and gas conservation commission - composition - authority - financial assurance requirements - pooling - appropriation. The act prioritizes the protection of public safety, health, welfare, and the environment in the regulation of the oil and gas industry by modifying the oil and gas statutes and by clarifying, reinforcing, or establishing various aspects of local governments' regulatory authority over the surface impacts of oil and gas development.

Current law specifies that local governments have so-called "House Bill 1041" powers, which are a type of land use authority over oil and gas mineral extraction areas, only if the Colorado oil and gas conservation commission (commission) has identified a specific area for designation. Sections 1 and 2 of the act repeal that limitation.

Section 3 directs the air quality control commission to review its rules to consider whether to adopt more stringent rules and to adopt rules to minimize emissions of methane and other hydrocarbons, volatile organic compounds, and oxides of nitrogen.

Section 4 clarifies that local governments have land use authority to regulate the siting of oil and gas locations to minimize adverse impacts to public safety, health, welfare, and the environment and to regulate land use and surface impacts, including the ability to inspect oil and gas facilities; impose fines for leaks, spills, and emissions; and impose fees on operators or owners to cover the reasonably foreseeable direct and indirect costs of permitting and regulation and the costs of any monitoring and inspection program necessary to address the impacts of development and enforce local governmental requirements. Section 4 also allows a local government or oil and gas operator to request the director of the commission to convene a technical review board to evaluate the effect of the local government's preliminary or final determination on the operator's application.

Section 5 repeals an exemption for oil and gas production from counties' authority to regulate noise.

The remaining substantive sections of the act amend the "Oil and Gas Conservation Act" (Act). The legislative declaration for the Act states that it is in the public interest to "foster" the development of oil and gas resources in a manner "consistent" with the protection of public health, safety, and welfare, including protection of the environment and wildlife resources; this has been construed to impose a balancing test between fostering oil and gas development and protecting public health, safety, and welfare. Section 6 states that the public interest is to "regulate" oil and gas development to "protect" those values.

Currently, the Act defines "waste" to include a diminution in the quantity of oil or gas that ultimately may be produced. Section 7 excludes from that definition the nonproduction of oil or gas as necessary to protect public health, safety, welfare, the environment, or wildlife resources. Section 7 also repeals the requirement that the commission take into consideration cost-effectiveness and technical feasibility with regard to actions and decisions taken to minimize adverse impacts and repeals the limitation of the term "minimize adverse impacts" to wildlife resources.

The 9-member commission currently includes the executive directors of the departments of natural resources and public health and environment as ex officio members, 3 members who must have substantial experience in the oil and gas industry, and one member who must have training or experience in environmental or wildlife protection. Section 8 reduces the number of industry members to one and requires one member with training or substantial experience in wildlife protection; one member with training or substantial experience in environmental protection; one member with training or substantial experience in soil conservation or reclamation or technical expertise relevant to the issues considered by the commission; one member who is an active agricultural producer or a royalty owner; and one member with training or substantial experience in public health. This version of the commission is repealed on the earlier of July 1, 2020, or the date on which 3 specific rules promulgated by the commission have become effective. On that date, section 9, which creates a professional 5-member commission (along with the 2 ex officio executive directors), becomes effective.

Section 10 requires the director of the commission to hire up to 2 deputy directors. Upon receipt of a request for a technical review, the director is required to appoint technical review board members.

The Act currently specifies that the commission has exclusive authority relating to the conservation of oil or gas. Section 11 clarifies that nothing in the Act alters, impairs, or negates the authority of:

• The air quality control commission to regulate the air pollution associated with oil and gas operations;
• The water quality control commission to regulate the discharge of water pollutants from oil and gas operations;
• The state board of health to regulate the disposal of naturally occurring radioactive materials and technologically enhanced naturally occurring radioactive materials from oil and gas operations;
• The solid and hazardous waste commission to regulate the disposal of hazardous waste and exploration and production waste from oil and gas operations; or
• A local government to regulate land use related to oil and gas operations, including specifically the siting of an oil and gas location.

Currently, an operator first gets a permit from the commission to drill one or more wells within a drilling unit, which is located within a defined area, and then notifies the applicable local government of the proposed development and seeks any necessary local government approval. Section 12 requires operators to file, with the application for a permit to drill, either: Proof that the operator has already filed an application with the affected local government to approve the siting of the proposed oil and gas location and of the local government's disposition of the application; or proof that the affected local government does not regulate the siting of oil and gas locations. Section 12 also specifies that, until the commission has promulgated rules regarding 3 specific topics and the rules have become effective, the director may delay the final determination regarding a permit if the director, following a public comment period, determines that the permit requires additional analysis to ensure the protection of public health, safety, and welfare or the environment or requires additional local government or other state agency consultation.

Pursuant to commission rule, an operator may submit a statewide blanket financial assurance of $60,000 for fewer than 100 wells or $100,000 for 100 or more wells. Section 12 directs the commission to adopt rules that require financial assurance sufficient to provide adequate coverage for all applicable requirements of the Act. Current law allows the commission to set numerous fees used to administer the Act and sets a $200 or $100 cap on the fees. Section 12 eliminates the caps and requires the commission to set a permit application fee in an amount sufficient to recover the commission's reasonably foreseeable direct and indirect costs in conducting the analysis necessary to assure that permitted operations will be conducted in compliance with all applicable requirements of the Act.

Current law gives the commission the authority to regulate oil and gas operations so as to prevent and mitigate "significant" adverse environmental impacts to the extent necessary to protect public health, safety, and welfare, taking into consideration cost-effectiveness and technical feasibility. Section 12 requires the commission to protect and minimize adverse impacts to public health, safety, and welfare, the environment, and wildlife resources and protect against adverse environmental impacts on any air, water, soil, or biological resource resulting from oil and gas operations. Section 12 also requires the commission to adopt rules that require alternate location analyses for oil and gas facilities that are proposed to be located near populated areas and that evaluate and address the cumulative impacts of oil and gas development. Finally, section 12 directs the commission to promulgate rules to:

• Ensure proper wellbore integrity of all oil and gas production wells, including the use of nondestructive testing of weld joints and requiring certification of several categories of oil and gas workers;
• Allow public disclosure of flowline information and to evaluate and determine when a deactivated flowline must be inspected before being reactivated; and
• Evaluate and determine when inactive, temporarily abandoned, and shut-in wells must be inspected before being put into production or used for injection.

Section 13 modifies the commission's administrative procedures, including by taking into account determinations made by administrative law judges.

Current law authorizes "forced" or "statutory" pooling, a process by which "any interested person", typically an operator who has at least one lease or royalty interest, may apply to the commission for an order to pool oil and gas resources located within a particularly identified drilling unit. After giving notice to interested parties and holding a hearing, the commission can adopt a pooling order to require an owner of oil and gas resources within the drilling unit who has not consented to the application (nonconsenting owner) to allow the operator to produce the oil and gas within the drilling unit notwithstanding the owner's lack of consent. Section 14 requires that the owners of more than 45% of the mineral interests to be pooled must have joined in the application for a pooling order and that the application include either: Proof that the applicant has already filed an application with the affected local government to approve the siting of the proposed oil and gas facilities and of the local government's disposition of the application; or proof that the affected local government does not regulate the siting of oil and gas facilities. Section 14 also specifies that the operator cannot use the surface owned by a nonconsenting owner without permission from the nonconsenting owner.

Current law also sets the royalty that a nonconsenting owner is entitled to receive at 12.5% of the full royalty rate until the consenting owners have been fully reimbursed (out of the remaining 87.5% of the nonconsenting owner's royalty) for their costs. Section 14 raises a nonconsenting owner's royalty rate during this pay-back period from 12.5% to 13% for gas and 16% for oil and makes corresponding reductions of the portions of the nonconsenting owner's royalty from which the consenting owners' costs are paid.

Current law requires the commission to ensure that the 2-year average of the unobligated portion of the oil and gas conservation and environmental response fund does not exceed $6 million and that there is an adequate balance in the environmental response account in the fund to address environmental response needs. Section 15 directs the commission to ensure that the unobligated portion of the fund does not exceed 50% of total appropriations from the fund for the upcoming fiscal year and that there is an adequate balance in the account to support the operations of the commission and to address environmental response needs.

Section 16 specifies that for permit-specific conditions for wildlife habitat protection, the commission is required to consult with and obtain consent from a surface owner only if the permit-specific conditions directly impact the affected surface owner's property or use of that property.

Section 17 amends preemption law by specifying that both state agencies and local governments have authority to regulate oil and gas operations and establishes that local government requirements may be more protective or stricter than state requirements.

Section 18 appropriates $851,010 to the department of natural resources to implement the act.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Paid family and medical leave - study - task force created - appropriation. The act creates a study of the implementation of a paid family and medical leave program in the state by:

• Requiring the department of labor and employment to contract with experts in the field of paid family and medical leave to report on the establishment of a paid family and medical leave program for employees in the state;
• Requiring the department to request information from third parties that may be willing to administer all or part of a paid family and medical leave program;
• Creating the family and medical leave implementation task force, which is responsible for recommending a plan to implement a paid family and medical leave program for the state; and
• Requiring an actuarial study of the final plan recommended by the task force.

To implement the act, $165,487 is appropriated to the department of labor and employment and $17,004 is appropriated to the department of public health and environment. Both appropriations are from the general fund.

(Note: This summary applies to this bill as enacted.)

Fiscal Note

Wraparound services - child and youth behavioral health delivery system pilot program - standardized screening tools - single statewide referral and entry point - children and youth at risk of out-of-home placement or in an out-of-home placement - appropriation. No later than July 1, 2020, the department of health care policy and financing shall seek federal authorization to provide wraparound services for eligible children and youth who are at risk of out-of-home placement or in an out-of-home placement. Upon federal authorization, the department of health care policy and financing shall require managed care entities to implement wraparound services, which may be contracted out to a third party.

The act requires the department of health care policy and financing, in conjunction with the department of human services, to develop and implement wraparound services for children and youth at risk of out-of-home placement or in an out-of-home placement. The act requires wraparound services to be covered under medicaid. Upon implementation of the wraparound services, the department of health care policy and financing and the department of human services shall monitor and report the annual cost savings associated with eligible children and youth receiving wraparound services to the public through the annual "SMART Act" hearing.

No later than July 1, 2020, the department of health care policy and financing is required to design and recommend a child and youth behavioral health delivery system pilot program that addresses the challenges of fragmentation and duplication of behavioral health services.

The act requires the executive director of the department of human services to appoint two full-time staff persons to support and facilitate interagency coordination for the development and implementation of wraparound services.

No later than July 1, 2020, the department of human services is required to select a single standardized assessment tool to facilitate identification of behavioral health issues and develop a plan to implement the tool for programmatic utilization. The act also requires the department of human services to select developmentally appropriate and culturally competent statewide behavioral health standardized screening tools for primary care providers, which may be made available electronically for health care professionals. The department of public health and environment shall ensure adequate statewide training on the standardized screening tools for primary care providers and other interested health care professionals who care for children.

No later than July 1, 2020, the department of human services, in conjunction with the department of health care policy and financing and the department of public health and environment, is required to develop a plan for establishing a single statewide referral and entry point for children and youth who have a positive behavioral health screening or whose needs are identified through a standardized assessment.

The act makes multiple appropriations to the department of health care policy and financing and the department of human services.

(Note: This summary applies to this bill as enacted.)

Fiscal Note